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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311418
Report Date: 03/02/2022
Date Signed: 03/02/2022 02:49:35 PM


Document Has Been Signed on 03/02/2022 02:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:LEMUS, GLORIAFACILITY NUMBER:
304311418
ADMINISTRATOR:LEMUS, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 835-3802
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY:14CENSUS: 7DATE:
03/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Gloria Lemus - LicenseeTIME COMPLETED:
03:05 PM
NARRATIVE
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A case management inspection was conducted today by Licensing Program Analyst (LPA), Carmen Odom who met with Licensee, Gloria Lemus. A self reported incident by the facility was received at the licensing office on 12/10/21 which stated on 12/08/21 at 3:30pm, Licensee (S1) and Adult #1 (A1) had an argument at the childcare facility, during the argument A1 recorded from the second floor of the facility a child crying.

Census was taken today and there was a total of 4 infants, and 3 school age children napping with 1 assistant. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During this investigation, LPA interviewed Licensee, 1 adult, and 4 children. LPA also obtained a copy of the children roster, video and screen shots. S1 disclosed on the day of the incident Child #1 (C1) pushed Child #2 (C2) in the hallway of the childcare area causing for C2 to cry. While S1 was attending to C2, A1 was video recording C2 cry from the second floor of the facility. Throughout the investigation, 4 children were interviewed on 12/14/21 and 1/26/22. During the interviews all 4 children disclosed that they did not observe or remember C2 crying in the hallway. It was disclosed by all the children, S1 will give the children time out on the bench when they do not listen or behave. It was also disclosed by 3 out of 4 children that S1 has pinched their hand when they do not listen or behave. Based on the information gathered from the interviews conducted, and records reviewed. It was determined that S1 has violated the children’s personal rights.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation 102423(a)(4) was issued today on the attached LIC 809D.

This report cites Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEMUS, GLORIA
FACILITY NUMBER: 304311418
VISIT DATE: 03/02/2022
NARRATIVE
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Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee Gloria Lemus was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/02/2022 02:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: LEMUS, GLORIA
FACILITY NUMBER: 304311418

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/02/2022
Section Cited

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102423 Personal Rights (a)Each child receiving services from a family childcare home shall have certain rights... These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule... This requirement was not met evidence by:
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Based on children interviews 3 out 4 children disclosed that Licensee has pinched the children’s hand when the children do not behave or listen. This is an immediate Health and Safety risk to the children in care.
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statement by 3/2/22 to licesing office.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
LIC809 (FAS) - (06/04)
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